New Beginnings Doula Training

New Beginnings Doula Training
Courses for doulas and online childbirth education

Monday, July 18, 2011

How to push during labor-what the current research says

I can not tell you how often doctors and other nurses would look at me strange when I would push with women during labor. Not only would I have them on their sides or sitting up(even with an epidural), but I very rarely encouraged women to take a deep breathe, count to 10 and push down as hard as they could. Why didn't I do this? Because most research I read showed that this was not the best way to deal with second stage labor(or the pushing stage). Instead, I would encourage them to go with their own natural urges. If they were using an epidural, I would still encourage this if they could feel anything. If they couldn't, I would encourage them to wait a little bit to push and then just push for as long as they wanted. They could even let their air out a little if they wanted. If they baby was having more problems, I would have them wait a few contractions to allow both them and the baby to take a break. This is all based off of current up to date research that showed that both babies and moms did better with this kind of pushing.

I did have some nurses tell my manager that I did not know how to deal with this stage of labor, and there were doctors that would not trust me alone in the room with their patient because of this. I had to laugh when I would see some doctors poke their heads through the door to make sure I was doing it the right way:) How could I do it their way, though, when I knew that there was nothing to back up how they did it. Here's an interesting excerpt that explains the dilemma as well as current research.

"Provider preferences and individual patient preferences also influence how successfully evidence is translated into practice. An example of how provider preferences may influence the implementation of evidence-based change into practice is open glottis pushing versus closed glottis pushing during second-stage labor.

Early research clearly demonstrated that closed glottis pushing compared with open glottis pushing caused detrimental hemodynamic changes.22 However, women in second-stage labor are still told by their labor nurses to "take a deep breath and push" as hard as they can and as long as they can. This closed glottis pushing using a Valsalva maneuver decreases oxygenation and is in part why limitations of 1 to 2 hours have been placed on the length of second-stage labor. In the late 1970s and early 1980s, there was a movement to change to the more natural open glottis pushing, in which women made noise while they were pushing. However, in an evidence-based practice demonstration, one barrier to changing from closed glottis to open glottis pushing was noted to be provider discomfort. With open glottis pushing, patients made guttural noises that sounded to some providers like the noises made during lovemaking or defecation and these noises made some providers uncomfortable."


Enjoy Birth said...

Love your insights into pushing! I so agree with the way you do it. :)

Kacie said...

If you're holding your breath while pushing, you can't make those mama bear sounds that seem to help get the baby out! :)

Amy said...

When I gave birth last year, my midwife kept telling me I was "wasting energy" by making noise while pushing. I was sure that I had read that this idea was untrue, but I was doubting myself. In the end, I couldn't figure out how to push without noise, so I just ignored the midwife! I am going to bookmark this post to read before I have another baby (God willing!).

Rachel said...

Amy, I'm going to do a follow up blog on your comment:)...just thought I'd let you know.

sady said...

Women really need to be taught this and feel comfortable with making noise during labor. My doula explained open-glottis pushing to me about 2 weeks before delivery and I tried it. I really think it made all the difference in delivering my son without medication and by VBAC. People including nurses and doctors need to be comfortable with some noise being made during labor. Hard work is not always quiet.

Birth is a Journey: Does it have to be life changing?

  • One woman might have to climb on an overfilled boat, risking her life and nearly dying as she escapes over the ocean to come to this land. This experience could certainly be life altering. It may very well color the rest of her life, positively or negatively. (I overcame this amazing struggle and here I am triumphant! OR Holy crap, that was SO hard I don’t know if I can go on! By the way, neither response is “right”. No one would judge the woman with the 2nd response.)
  • One woman may buy an airplane ticket, sit on a comfortable 747 and fly to America with a nice smooth flight and landing. She is happy to be in America. Those welcoming her are glad she is here safe and sound. She may only travel by plane 2-4 times in her life, so it is pretty memorable. But the journey itself probably wouldn’t be life changing; it would simply be a journey.
  • One woman may learn to fly an ultra-light plane to lead a flock of geese into America teaching them to migrate. This experience could certainly be empowering and life altering.